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Regimented Sodium Replacement vs Ad Lib Consumption of High Sodium Fluids in NFL Players Arthur Bartolozzi, MD Pennsylvania Hospital, Philadelphia PA Sandra.

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Presentation on theme: "Regimented Sodium Replacement vs Ad Lib Consumption of High Sodium Fluids in NFL Players Arthur Bartolozzi, MD Pennsylvania Hospital, Philadelphia PA Sandra."— Presentation transcript:

1 Regimented Sodium Replacement vs Ad Lib Consumption of High Sodium Fluids in NFL Players Arthur Bartolozzi, MD Pennsylvania Hospital, Philadelphia PA Sandra Fowkes Godek, PhD West Chester University C Peduzzi, ATC, S Condon, ATC, R Burkholder, ATC Philadelphia Eagles The HEAT Institute of West Chester University

2 BackgroundBackground We previously reported that hypovolemic hyponatremia occurs in un-supplemented college and professional football (NFL) players We previously reported that hypovolemic hyponatremia occurs in un-supplemented college and professional football (NFL) players Fowkes Godek S, Bartolozzi AR. Changes in blood electrolytes and plasma volume in NFL football players during pre-season training. Athl Train Sports Health Care. 2009;1(6): We subsequently supplemented NFL players with Rehydralyte and pickle juice and successfully maintained fluid balance We subsequently supplemented NFL players with Rehydralyte and pickle juice and successfully maintained fluid balance We previously reported that hypovolemic hyponatremia occurs in un-supplemented college and professional football (NFL) players We previously reported that hypovolemic hyponatremia occurs in un-supplemented college and professional football (NFL) players Fowkes Godek S, Bartolozzi AR. Changes in blood electrolytes and plasma volume in NFL football players during pre-season training. Athl Train Sports Health Care. 2009;1(6): We subsequently supplemented NFL players with Rehydralyte and pickle juice and successfully maintained fluid balance We subsequently supplemented NFL players with Rehydralyte and pickle juice and successfully maintained fluid balance

3 BackgroundBackground Previous field research indicates that sodium replacement helps maintain sodium balance, plasma volume and body weight in football players during pre-season. Previous field research indicates that sodium replacement helps maintain sodium balance, plasma volume and body weight in football players during pre-season. It is unclear whether ad libitum consumption of high sodium fluids maintains sodium and fluid balance as well as athlete specific sodium replacement using high sodium fluids and sodium capsules. It is unclear whether ad libitum consumption of high sodium fluids maintains sodium and fluid balance as well as athlete specific sodium replacement using high sodium fluids and sodium capsules. Previous field research indicates that sodium replacement helps maintain sodium balance, plasma volume and body weight in football players during pre-season. Previous field research indicates that sodium replacement helps maintain sodium balance, plasma volume and body weight in football players during pre-season. It is unclear whether ad libitum consumption of high sodium fluids maintains sodium and fluid balance as well as athlete specific sodium replacement using high sodium fluids and sodium capsules. It is unclear whether ad libitum consumption of high sodium fluids maintains sodium and fluid balance as well as athlete specific sodium replacement using high sodium fluids and sodium capsules.

4 MethodsMethods The supplementation protocol took place during the first 10 days of preseason training camp The supplementation protocol took place during the first 10 days of preseason training camp We measured We measured blood electrolytesblood electrolytes urine osmolalityurine osmolality changes in plasma volume (% PV)changes in plasma volume (% PV) body mass (% mass)body mass (% mass) The supplementation protocol took place during the first 10 days of preseason training camp The supplementation protocol took place during the first 10 days of preseason training camp We measured We measured blood electrolytesblood electrolytes urine osmolalityurine osmolality changes in plasma volume (% PV)changes in plasma volume (% PV) body mass (% mass)body mass (% mass)

5 Methods We hypothesized that We hypothesized that Fluids would not maintain blood sodium or increase PV compared to Capsules plus fluid replacement.

6 MethodsMethods Change in plasma volumes was calculated from Hct and Hb Change in plasma volumes was calculated from Hct and Hb Electrolytes were measure by ion- selective electrode Electrolytes were measure by ion- selective electrode Osmolality was measured by freezing point depression Osmolality was measured by freezing point depression Change in plasma volumes was calculated from Hct and Hb Change in plasma volumes was calculated from Hct and Hb Electrolytes were measure by ion- selective electrode Electrolytes were measure by ion- selective electrode Osmolality was measured by freezing point depression Osmolality was measured by freezing point depression

7 Design and Setting Observational cohort study Observational cohort study Study conducted during consecutive preseason training camps of one NFL team. Study conducted during consecutive preseason training camps of one NFL team. Year1 = capsulesYear1 = capsules Year2 = fluidsYear2 = fluids Observational cohort study Observational cohort study Study conducted during consecutive preseason training camps of one NFL team. Study conducted during consecutive preseason training camps of one NFL team. Year1 = capsulesYear1 = capsules Year2 = fluidsYear2 = fluids

8 SubjectsSubjects Eleven NFL players volunteered Eleven NFL players volunteered 6 players participated in both years and6 players participated in both years and the other 5 were physically matchedthe other 5 were physically matched Ht = 187 ± 5cm, Ht = 187 ± 5cm, Mass = ± 17kg Mass = ± 17kg BSA = 2.38 ± 0.17m 2 BSA = 2.38 ± 0.17m 2 Eleven NFL players volunteered Eleven NFL players volunteered 6 players participated in both years and6 players participated in both years and the other 5 were physically matchedthe other 5 were physically matched Ht = 187 ± 5cm, Ht = 187 ± 5cm, Mass = ± 17kg Mass = ± 17kg BSA = 2.38 ± 0.17m 2 BSA = 2.38 ± 0.17m 2

9 InterventionsInterventions Both years the players had 15 practices the first 9 days of camp Both years the players had 15 practices the first 9 days of camp Year 1: Capsules - players consumed sodium containing fluids and salt capsules at meals in amounts equal to 50% of daily sweat sodium losses Year 1: Capsules - players consumed sodium containing fluids and salt capsules at meals in amounts equal to 50% of daily sweat sodium losses Year 2: Fluids - players were encouraged to consume sodium containing fluid (458 mg to 1.1 gl -1 ) Year 2: Fluids - players were encouraged to consume sodium containing fluid (458 mg to 1.1 gl -1 ) ad libitum but were not instructed on specifically what to drink Both years the players had 15 practices the first 9 days of camp Both years the players had 15 practices the first 9 days of camp Year 1: Capsules - players consumed sodium containing fluids and salt capsules at meals in amounts equal to 50% of daily sweat sodium losses Year 1: Capsules - players consumed sodium containing fluids and salt capsules at meals in amounts equal to 50% of daily sweat sodium losses Year 2: Fluids - players were encouraged to consume sodium containing fluid (458 mg to 1.1 gl -1 ) Year 2: Fluids - players were encouraged to consume sodium containing fluid (458 mg to 1.1 gl -1 ) ad libitum but were not instructed on specifically what to drink

10 MethodsMethods Blood samples for baseline measures were obtained when players reported to camp and prior to the morning practice on Days 3, 5 and 10 Blood samples for baseline measures were obtained when players reported to camp and prior to the morning practice on Days 3, 5 and 10

11 MethodsMethods Baseline mass was recorded after urine samples ensured euhydration Baseline mass was recorded after urine samples ensured euhydration Capsules osmolality 637 ± 304 mOsmkg -1Capsules osmolality 637 ± 304 mOsmkg -1 Fluids osmolality 725 ± 301 mOsmkg -1Fluids osmolality 725 ± 301 mOsmkg -1 Capsules USG ±.008Capsules USG ±.008 Fluids USG ±.009Fluids USG ±.009 Baseline mass was recorded after urine samples ensured euhydration Baseline mass was recorded after urine samples ensured euhydration Capsules osmolality 637 ± 304 mOsmkg -1Capsules osmolality 637 ± 304 mOsmkg -1 Fluids osmolality 725 ± 301 mOsmkg -1Fluids osmolality 725 ± 301 mOsmkg -1 Capsules USG ±.008Capsules USG ±.008 Fluids USG ±.009Fluids USG ±.009

12 Data Analysis Dependent Variables: Dependent Variables: %PV%PV %mass%mass blood sodiumblood sodium potassium and chloridepotassium and chloride Two-way ANOVA with repeated measures and correlated t-tests Two-way ANOVA with repeated measures and correlated t-tests Dependent Variables: Dependent Variables: %PV%PV %mass%mass blood sodiumblood sodium potassium and chloridepotassium and chloride Two-way ANOVA with repeated measures and correlated t-tests Two-way ANOVA with repeated measures and correlated t-tests

13 ResultsResults Mean WBGT during practices for days 1- 9 were not different Mean WBGT during practices for days 1- 9 were not different Capsules 25 ± 3.5ºCCapsules 25 ± 3.5ºC Fluids 25.5 ± 3.1ºCFluids 25.5 ± 3.1ºC Mean WBGT during practices for days 1- 9 were not different Mean WBGT during practices for days 1- 9 were not different Capsules 25 ± 3.5ºCCapsules 25 ± 3.5ºC Fluids 25.5 ± 3.1ºCFluids 25.5 ± 3.1ºC

14 Results - Soduim Sodium was lower on Sodium was lower on Days 3 and 5 in Fluids versus Capsules ± 1.4 vs ± 1.5mmoll ± 1.4 vs ± 1.5mmoll -1 P = Capsules group sodium remained unchanged Capsules group sodium remained unchanged Fluids group returned to baseline at day 10 Fluids group returned to baseline at day 10

15 Results - Chloride Fluids group was lower from baseline on days 3 and 5 and returned to baseline at day 10 Fluids group was lower from baseline on days 3 and 5 and returned to baseline at day 10 p = 0.05 Capsules group statistically unchanged Capsules group statistically unchanged Fluids group was lower from baseline on days 3 and 5 and returned to baseline at day 10 Fluids group was lower from baseline on days 3 and 5 and returned to baseline at day 10 p = 0.05 Capsules group statistically unchanged Capsules group statistically unchanged

16 Results - Potassium Both groups decrease from baseline at day 3 Both groups decrease from baseline at day 3 p < 0.01 Capsules group increased above baseline by day 5 Capsules group increased above baseline by day 5 p < 0.01 Both groups increased to above baseline by day 10 Both groups increased to above baseline by day

17 Results - Plasma Volume Capsules group PV increased Capsules group PV increased 11% by day 3,11% by day 3, 12.4% by day 512.4% by day 5 remained at 9.3% elevated by day 10 over baselineremained at 9.3% elevated by day 10 over baseline Fluids group PV Fluids group PV Decreased -0.6% on day 3Decreased -0.6% on day 3 Significantly lower than capsules group on day 3Significantly lower than capsules group on day 3 Capsules group PV increased Capsules group PV increased 11% by day 3,11% by day 3, 12.4% by day 512.4% by day 5 remained at 9.3% elevated by day 10 over baselineremained at 9.3% elevated by day 10 over baseline Fluids group PV Fluids group PV Decreased -0.6% on day 3Decreased -0.6% on day 3 Significantly lower than capsules group on day 3Significantly lower than capsules group on day 3 11% 12.4% 9.3%

18 Results – Body Mass No differences were found for % mass. No differences were found for % mass.

19 ConclusionsConclusions Sodium and chloride remained constant during the first 10 days of preseason in NFL players who replaced 50% of their daily sweat sodium losses using a regimented dosing with sodium capsules and fluid replacement Sodium and chloride remained constant during the first 10 days of preseason in NFL players who replaced 50% of their daily sweat sodium losses using a regimented dosing with sodium capsules and fluid replacement In players using ad libidum fluid replacement, sodium and chloride dropped below baseline at days 3 and 5 In players using ad libidum fluid replacement, sodium and chloride dropped below baseline at days 3 and 5 Sodium and chloride remained constant during the first 10 days of preseason in NFL players who replaced 50% of their daily sweat sodium losses using a regimented dosing with sodium capsules and fluid replacement Sodium and chloride remained constant during the first 10 days of preseason in NFL players who replaced 50% of their daily sweat sodium losses using a regimented dosing with sodium capsules and fluid replacement In players using ad libidum fluid replacement, sodium and chloride dropped below baseline at days 3 and 5 In players using ad libidum fluid replacement, sodium and chloride dropped below baseline at days 3 and 5

20 Conclusions % PV was higher on day 3 in the Capsules group and remained elevated while PV did not increase until day 5 in the Fluids group % PV was higher on day 3 in the Capsules group and remained elevated while PV did not increase until day 5 in the Fluids group Elevated blood potassium levels occurred in both groups Elevated blood potassium levels occurred in both groups

21 Discussion Our results support the use of individualized dry sodium replacement along with sodium containing fluids during training camp as superior to ad libidum intake of high sodium fluids as a fluid replacement strategy Our results support the use of individualized dry sodium replacement along with sodium containing fluids during training camp as superior to ad libidum intake of high sodium fluids as a fluid replacement strategy

22 Discussion Plasma volume increase is supported by pill augmentation of sodium replacement and the delay in plasma volume increase using ad libidum replacement may be clinically relevant and may affect performance Plasma volume increase is supported by pill augmentation of sodium replacement and the delay in plasma volume increase using ad libidum replacement may be clinically relevant and may affect performance

23 What specific replacement do each of these athletes need? Sweat rates are different Sweat sodium is different What is the effect on performance Sweat rates are different Sweat sodium is different What is the effect on performance

24 Pennsylvania Hospital The Nations First The Nations First Thank You


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